Berger J R, Levy R M
Department of Neurology, University of Miami School of Medicine, Florida.
Med Clin North Am. 1993 Jan;77(1):1-23. doi: 10.1016/s0025-7125(16)30269-3.
The physician caring for HIV-1-infected patients must have a good working knowledge of the broad spectrum of neurologic diseases that occur in association with this infection. As with any other neurologic disorder, the site of the neuraxis that is affected must be properly identified. In HIV-1-infected persons, more than one site may be involved simultaneously, such as the coexistence of myelopathy and peripheral neuropathy, often resulting in a confusing array of neurologic signs and symptoms. The frequent occurrence of two or more diseases affecting the neuraxis, such as progressive multifocal leukoencephalopathy and toxoplasmosis, further complicates the picture. With the AIDS patient, the physician cannot rely on the clinical adage that all attempts should be made to ascribe the patient's problems to one disease. Often, it is not the case. As with other illnesses, the approach to the HIV-1-infected person with neurologic disease needs to be thorough and fluid. After rendering a diagnosis and embarking on therapy, the physician needs to be open minded about the possibility of an incorrect or additional diagnosis not previously considered. Lastly, despite all the knowledge that has been accumulated in the first decade of the AIDS epidemic, new illnesses occurring with HIV-1 infection are recognized with regularity. The physician must always bear in mind that the illness with which he or she is confronted may be one that has not been previously described.
负责治疗HIV-1感染患者的医生必须对与这种感染相关的广泛神经系统疾病有充分的了解。与任何其他神经系统疾病一样，必须正确识别受影响的神经轴部位。在HIV-1感染者中，可能会同时涉及多个部位，例如脊髓病和周围神经病变并存，常常导致一系列令人困惑的神经体征和症状。影响神经轴的两种或更多种疾病频繁发生，如进行性多灶性白质脑病和弓形虫病，使情况更加复杂。对于艾滋病患者，医生不能依赖“应尽一切努力将患者的问题归因于一种疾病”这一临床格言。通常并非如此。与其他疾病一样，对患有神经系统疾病的HIV-1感染者的治疗方法需要全面且灵活。在做出诊断并开始治疗后，医生需要对之前未考虑到的错误诊断或额外诊断的可能性持开放态度。最后，尽管在艾滋病流行的头十年积累了所有这些知识，但与HIV-1感染相关的新疾病仍经常被发现。医生必须始终牢记，他或她所面对的疾病可能是一种以前未被描述过的疾病。
